CHAPTER
3

Fat Isn’t Just Fat Anymore

In This Chapter

Benjamin Franklin said, “I guess I don’t so much mind being old, as much as I mind being fat and old.”

Many of us love to eat, but if we love it too much, and we don’t exercise or otherwise counterbalance that eating, we get fat. But “fat” means more than XXL labels on your clothes. Fat makes us feel physically uncomfortable, causes inflammation, and puts our lives in jeopardy.

In this chapter, you learn about the relationship between fat and inflammation, including the discovery that fat actually produces a protein that causes inflammation. We look at how to tell if you’re overweight or obese, the surprising risk of malnourishment for people who are overweight, and the benefits of eating whole grains to combat obesity. We also explore metabolic syndrome, which can put you at high risk for heart disease and diabetes.

A Modern-Day Disease

As a nation, we’re getting fat. In the last two decades, obesity has risen dramatically in the United States. Nearly two thirds of adults over age 20 are obese or overweight. (It’s interesting that the proportion of men who are overweight or obese is higher than the proportion of women in this category.)

If we look at obesity alone, 20 percent of adults 20 years of age and older—over 60 million people—are now obese. The percentage of young people who are overweight has more than tripled since 1980. Only 33.5 percent of adults are at healthy weights.

Among children and teens aged 6 to 19 years, 16 percent are overweight. An additional 15 percent of children and 15 percent of adolescents are at risk of being overweight, and these numbers are quickly rising.

Why Are We Fat?

Why are so many people overweight or obese? Several factors come into play.

We eat ready-made foods and use ready-made ingredients for cooking. These are often high in calories, harmful fats, and refined starches—all of which add to obesity.

We drive more and walk less, even if we’re going short distances, and we use modern appliances rather than our muscles. Many of our activities are sedentary. We sit and watch TV, sit at the computer, and sit while we play video games.

What’s more, many of our occupations are sedentary.

Fat Shortens Life

Many studies show a risk of early death due to obesity. In fact, people who are obese have a 50 to 100 percent increased risk of death from all causes compared with normal-weight individuals. Most of the high risk is due to heart problems, which, as we know, are closely tied to inflammation. (More on the link between fat and inflammation in a second.)

DID YOU KNOW?

According to the surgeon general of the United States, an estimated 300,000 deaths per year may be attributable to obesity, and the risk of death rises with increasing weight. Even moderate weight excess (10 to 20 pounds for a person of average height) increases the risk of death, particularly among adults aged 30 to 64 years.

The National Institutes of Health estimate that the life expectancy of a moderately obese person could be shortened by 2 to 5 years. And over the next few decades, life expectancy for the average American could decline by as much as 5 years unless our country’s obesity epidemic is stopped.

Fat and Inflammation

Until the last decade, fat was thought of as a passive, unattractive blob that provided insulation against the cold and affected how we moved and looked. However, scientists have learned that fat is much more than that.

Fat actually plays a very important role in your body functions. Fat cells send out chemical signals throughout your body, including to your brain, reproductive organs, and immune system. And researchers are still discovering hormones made by fat.

Fat is as much a functioning part of your body as your liver or pancreas. In recent years, researchers have found that fat is the biggest endocrine organ we have, which means it’s the largest part of our bodies producing hormones. And the fatter you are, the greater the effect that fat has on the rest of your body.

DEFINITION

Hormones act as chemical messengers and are transported to all parts of the body by the bloodstream, where they affect target organs. An endocrine organ is a part of the body that secretes hormones.

Scientists have also discovered that human fat cells produce a protein that causes inflammation. If you’re overweight, this explains why you probably have high levels of C-reactive protein (CRP), too.

Also, we know that being overweight or obese puts your body into an inflammatory state, and too much fat greatly increases the risk of inflammatory diseases such as cancer, diabetes, and arthritis.

If you’re overweight, losing even 10 to 15 pounds can ease the burden and stress fat puts on your body. Experts in obesity recommend about a 10 percent weight loss over a 6-month period. Following the anti-inflammation diet and lifestyle can help you achieve this goal.

Overweight Versus Obesity

The standard definition of overweight is an excess of body weight compared to guidelines set by the Centers for Disease Control and Prevention. The excess weight may come from muscle, bone, fat, and/or body water. Obesity refers specifically to having an abnormally high proportion of body fat.

WHAT THE EXPERTS SAY

With increasing body mass the risks of heart disease, high blood pressure, gallstones, and Type II diabetes all steadily increase, even among those in the healthy weight category.

—Dr. Walter Willett, author of Eat, Drink, and Be Healthy

To determine whether you’re overweight or obese, you can use the body mass index (BMI). Many health professionals use the BMI, so it’s important to understand it and know how to use it.

However, the measure of your waist is in many ways a better predictor of obesity and the metabolic syndrome, a condition in which a group of risk factors for cardiovascular disease and type 2 diabetes occur together (more on this later in the chapter). For most people, waist measurement correlates with their amount of body fat.

Measurements and Calculations

Measuring your waist is simple enough. Place a tape measure around your bare abdomen just above your hipbones. Be sure the tape is snug but not too tight. You shouldn’t feel pressure on your skin. Also, the tape should be parallel to the floor; it should not follow your belt line. Relax, breathe out, but do not breathe back in. Then measure your waist.

Calculating your BMI is a bit more complicated. To determine BMI using pounds and inches, multiply your weight in pounds by 704.5, divide the result by your height in inches, and divide that result by your height in inches a second time.

DIET DO

The multiplier 704.5 used for BMI is used by the National Institutes of Health. Other organizations may use a slightly different multiplier. For example, the American Dietetic Association suggests multiplying by 700. The variation in outcome (a few tenths) is insignificant.

An adult who has a BMI between 25 and 29.9 is considered overweight. An adult who has a BMI between 30 and 39 is considered obese. And adult with a BMI of 40 or higher is considered extremely obese.

By this standard, if you’re 5 feet, 9 inches tall and weigh between 169 and 202 pounds, for example, your body mass index is 25 to 29.9, and you’re considered overweight. If you’re 5 feet, 9 inches tall and you weigh 203 pounds or more, your body mass index is 30 or higher, and you’re considered obese.

To use this BMI table, find your height in the left Height column, and look across the row to find your weight. The number at the top of the column where your height and weight meet is your BMI. (Pounds have been rounded off.)

One important point to keep in mind: BMI measurements aren’t always accurate. If you’re muscular, you may have a BMI in the overweight range even though you don’t have excess body fat. Or if you have low muscle mass, you may have a BMI in the healthy weight category when actually you’re undernourished.

BMI, Kids, and Teens

For children and teens, BMI ranges above a normal weight have different labels: at risk of overweight and overweight.

BMI measurement is different for these age groups than for adults. Children’s body fat changes over the years as they grow, and girls and boys differ in how they store fat as they mature. BMI for children, also referred to as BMI-for-age, is gender and age specific.

BMI-for-age is plotted on gender-specific growth charts. These charts are used for children and teens 2 to 20 years of age. For the CDC growth charts and additional information, visit cdc.gov/growthcharts.

Overweight and Malnourished

In affluent, developed countries such as the United States, many people have easy access to food and can become overly plump. For the first time in human history, the number of overweight people in the world rivals the number of underweight people, according to a report by the Worldwatch Institute, a Washington, D.C.–based research organization.

And as the world gets fatter, we are, ironically, seeing a dramatic increase in malnutrition, which, according to the World Health Organization, is “characterized by obesity and the long-term implications of unbalanced dietary and lifestyle practices that result in chronic diseases such as cardiovascular disease, cancer, and diabetes.”

The Worldwatch report states that while the world’s underfed population has declined recently to 1.1 billion (good news), the number of overweight people has surged to 1.1 billion (bad news). People who are overweight, like those who are underweight, often suffer from malnutrition, or a lack of nutrients and other important dietary elements needed for maintaining health.

Overweight and obese people are often malnourished because they eat a lot of empty calories, such as refined sugars, flour, and grains that have no nutritional value. Empty calories like these abound in fast foods.

According to Gary Gardner, a co-author of the Worldwatch report:

The hungry and the overweight share high levels of sickness and disability, shortened life expectancies, and lower levels of productivity—each of which is a drag on a country’s development. The public health impact is enormous: more than half of the world’s disease burden—measured in “years of healthy life lost”—is attributable to hunger, overeating, and widespread vitamin and mineral deficiencies.

WHAT THE EXPERTS SAY

For every 2-pound increase in weight, the risk of developing arthritis is increased by 9 to 13 percent. In addition, symptoms of arthritis can improve with weight loss.

—Arthritis Foundation

If you eat a lot of empty-calorie foods, pay attention to the daily amount of nutrients you get. The author of the highly respected Eat, Drink, and Be Healthy, Dr. Walter Willett, suggests taking a multivitamin daily for insurance against vitamin and mineral deficiencies.

This doesn’t mean taking a multivitamin gives you the freedom to eat junk food. Sound nutrition doesn’t come in pills, and multivitamins simply cannot make up for the loss of nutrients found in wholesome foods.

Metabolic Syndrome

One of the major health problems caused by being overweight or obese is metabolic syndrome, a condition that puts people at high risk for type 2 diabetes and heart disease. It’s also closely linked to inflammation. Fortunately, if metabolic syndrome is caught early, it can be slowed or reversed.

Metabolic syndrome is a collection of problems that put people at high risk for serious disease. The exact cause of the syndrome is not known, but it’s believed to be a disorder of metabolism—your body’s process of breaking down and converting the food and liquids you consume into substances your body needs to function. Your genetic makeup, what you eat, and your exercise habits are also contributing factors.

DID YOU KNOW?

Metabolic syndrome is alarmingly common. In the United States, 22 percent of adults have it, and at least half of those over age 60 do, too, according to the Centers for Disease Control and Prevention. And a recent analysis found that as many as 4.2 percent of teenagers in the United States have the disorder.

If you carry fat mainly around your waist, you are more likely to develop metabolic syndrome than if you carry it in your hips and thighs. (You’ve probably heard these weight distributions called apple shaped and pear shaped.) In fact, a waist measurement better determines metabolic syndrome even if other measurements, such as BMI, fall within the normal range. Women with a waist measurement of more than 35 inches and men with a waist measurement of more than 40 inches are at high risk for metabolic syndrome.

Key features of metabolic syndrome are as follows:

If you have three or more of these conditions, you probably—or most likely—have metabolic syndrome and are high risk for heart disease.

Metabolic Syndrome and Inflammation

Chronic inflammation goes hand and hand with metabolic syndrome. Stomach fat actually produces chemical substances called cytokines, which cause the liver to make CRP—remember that from Chapter 1?

Also, the more features of the metabolic syndrome you have, the higher your CRP level.

Tackling Metabolic Syndrome

The American Heart Association recommends lifestyle therapies as the first-line interventions to reduce the risk of developing metabolic syndrome. It recommends the following:

Studies have shown that small decreases in weight—even in persons who are obese—can result in significant improvements in markers of metabolic syndrome. “It all comes down to lifestyle choices,” says Dr. S. Sethu Reddy, an endocrinologist at the Cleveland Clinic Foundation. “The best medication for metabolic syndrome is common sense.”

Sounds like the anti-inflammation diet and lifestyle doesn’t it?

Metabolic Syndrome, Inflammation, and Your Brain

Research shows that people with metabolic syndrome and high levels of inflammation are at very high risk for the brain-robbing condition dementia.

A recent study led by Dr. Kristine Yaffe of the University of California at San Francisco followed more than 2,600 men and women in their 70s. After 5 years, those with metabolic syndrome were 20 percent more likely to develop signs of cognitive impairment, including memory loss, than those without metabolic syndrome. Those with both metabolic syndrome and high levels of inflammation were 66 percent more likely to suffer from mental impairment.

DID YOU KNOW?

If you’re over 50, you have a better than 1 in 3 chance of having metabolic syndrome. The rate of people with metabolic syndrome has soared by more than 60 percent in the last decade, paralleling the steep rise in obesity among Americans young and old.

If you already have metabolic syndrome, the best thing you can do is get your weight down and then keep it down.

The best protection against metabolic syndrome is to lose weight and eat a health-promoting diet. Studies show that eating a Mediterranean-style diet, such as the anti-inflammation approach, and maintaining a healthful weight can ward off metabolic syndrome. That means a diet rich in foods that come from plants: grains, vegetables, fruits, beans, legumes, nuts, and olive oil. You’ll also reap the benefits of the high nutritional value of these foods, so even if you are overweight, you won’t also be malnourished.

Scientists at Tufts University found that following a diet rich in whole-grain foods can delay development of metabolic syndrome. Earlier studies found that eating whole grains reduced the risk of developing metabolic syndrome among middle-aged people. The scientists also found that people who consumed high amounts of refined grains had twice the risk of having metabolic syndrome than those people who consumed only small amounts.

Whole grains are not only good for you, they’re also delicious. We discuss whole grains in more detail in Chapter 8. In the meantime, we’ve included some delicious recipes at the end of this chapter to whet your appetite.

The Least You Need to Know

Mushroom Brown Rice Pilaf

Brown rice and mushrooms create an easy side dish with an earthy flavor. Courtesy of Oldways and the Whole Grains Council, wholegrainscouncil.org.

1 TB. olive or canola oil

1⁄2 large onion, chopped

4 or 5 mushrooms, sliced (1 cup)

1 cup brown rice

2 cups chicken or vegetable broth

  1. In a large saucepan over medium heat, heat olive oil. Add onion and mushrooms, and cook to brown for about 5 minutes.
  2. Add brown rice, and stir to coat.
  3. Add chicken broth, bring to a boil, and reduce heat to medium-low. Simmer for about 45 minutes or until broth is absorbed. (Cooking time can vary for whole-grain rice according to the variety. Check the package directions.)

Variation: In a hurry? Try bulgur or quinoa instead of the brown rice. Both cook in less than 15 minutes.

DID YOU KNOW?

Brown rice has its bran, germ, and endosperm intact, and it’s chewier and slower-cooking than milled white rice. It’s nutritious, has fewer calories per ounce, and comes in long and short varieties—which are interchangeable in recipes. Some cooks like to toast it first to achieve a nuttier flavor.

Curried Barley and Raisins

This Indian-inspired side dish stars sweet raisins and a delightful bit of crunch from the almonds. Courtesy of Oldways and the Whole Grains Council, wholegrainscouncil.org.

1⁄2 cup lightly pearled barley

2 cups chicken or vegetable broth or water

2 tsp. olive oil

1 large onion, thinly sliced (about 2 cups)

1 tsp. minced garlic

1 tsp. curry powder

2 TB. raisins

2 TB. chopped fresh parsley

2 TB. slivered almonds, toasted

Salt

Black pepper

  1. In a medium saucepan over high heat, bring pearled barley and chicken broth to a boil. Reduce heat to low, cover, and cook for about 45 minutes or until liquid is absorbed.
  2. Meanwhile, in a large skillet over medium heat, heat olive oil. Add onion, and sauté, stirring occasionally, for about 15 minutes or until golden brown.
  3. Add garlic and curry powder, stir, and cook for 1 minute.
  4. When barley is done, add it to the skillet and stir well to coat.
  5. Turn off heat, and add raisins, parsley, and almonds. Season with salt and pepper, and serve.

DIET DO

Barley’s not just for soups, as this dish shows. You also can add shrimp, chicken, or other lean protein to this recipe to make it a one-dish meal. Stir in at the end and just heat through.

Wild Rice Azteca

Smoky cumin and fresh cilantro bring a Mexican flavor to this easy rice dish. Courtesy of Oldways and the Whole Grains Council, wholegrainscouncil.org.

31⁄2 cups reduced-sodium chicken broth

3⁄4 cup wild rice

3⁄4 cup jasmine or other long-grain rice

2 TB. olive oil

1 medium onion, chopped

2 cloves garlic, minced or pressed

1 (14.5-oz.) can diced tomatoes, drained

1 canned chipotle chile, minced

1 tsp. ground cumin

1⁄3 cup minced fresh cilantro

1 medium avocado, peeled, seeded, and sliced (optional)

  1. In a 4- or 5-quart saucepan over high heat, bring chicken broth to a boil. Add wild rice; reduce heat to low, cover, and simmer for about 45 minutes or until grains begin to open and feel tender to bite.
  2. Stir in jasmine rice. Cover, and simmer for 20 to 25 more minutes or until both rices are tender to bite and all broth is absorbed.
  3. Meanwhile, in a 10- to 12-inch skillet over medium-high heat, heat olive oil. Add onion, garlic, diced tomatoes, chipotle chile, and cumin. Reduce heat to medium, and cook, stirring, for about 5 minutes or until heated through.
  4. When rices are done, remove from heat. Gently stir in onion-tomato mixture and cilantro, garnish each serving with avocado slices (if using), and serve.

Variation: To increase the spiciness, you can add a second chipotle chile.

DID YOU KNOW?

Wild rice is highly nutritious. It’s not actually a rice, but an annual water-grass seed, naturally abundant in the cold rivers and lakes of Minnesota and Canada. It was a staple in the diet of the Chippewa and Sioux Indians.

Big Protein Red Quinoa Salad

Lemon adds a bright flavor to this protein-rich salad. Reprinted with permission from Kathy Casey Food Studios.

3⁄4 cup red quinoa

11⁄2 cups water

1 tsp. minced garlic

2 TB. extra-virgin olive oil

1⁄4 cup fresh lemon juice

2 tsp. minced or grated lemon zest

1 small organic cucumber, peeled, seeded, and 1⁄4-in.-diced (1⁄2 cup)

1⁄2 cup canned organic chickpeas, rinsed and drained

1 TB. chopped fresh dill

1⁄2 cup chopped fresh parsley

1⁄2 cup organic golden raisins

1⁄2 cup organic hazelnuts, lightly toasted and coarsely chopped

1⁄4 cup thinly sliced green onions, white and green parts

1 small carrot, peeled and grated (1⁄4 cup)

3⁄4 to 1 tsp. sea salt

1⁄4 tsp. black pepper

  1. Rinse red quinoa in cold water and drain well. Place quinoa in a medium saucepan over medium heat, and dry-roast, stirring occasionally, for about 1 minute.
  2. Add water, bring to a boil, reduce heat to medium-low, and simmer, covered, for about 15 minutes or until water is absorbed.
  3. Remove from heat, and let stand, covered, for 10 minutes. Remove lid, fluff with a fork, and let cool to room temperature.
  4. In a large bowl, combine quinoa with garlic, extra-virgin olive oil, lemon juice, lemon zest, cucumber, chickpeas, dill, parsley, golden raisins, hazelnuts, green onions, carrot, sea salt, and black pepper. Toss well, and serve.

DID YOU KNOW?

Quinoa is a seed that comes from the Andes Mountains of South America. It contains a great deal of protein.

Bulgur and Black Bean Salad

The cumin and orange combine to bring a unique flavor to this simple salad. Courtesy of Oldways and the Whole Grains Council, wholegrainscouncil.org.

1 cup uncooked bulgur

2 cups water

1 medium orange

2 tsp. white vinegar

2 TB. canola or olive oil

1⁄2 tsp. ground cumin

1 medium red bell pepper, ribs and seeds removed, and chopped small

6 green onions, white and green parts, chopped small

4 TB. chopped fresh parsley

1 (14- or 15-oz.) can black beans, drained and rinsed

  1. In a medium saucepan over high heat, bring bulgur and water to a boil. Reduce heat to medium-low and simmer for 12 to 15 minutes or until excess water is absorbed.
  2. Scrub orange, and grate off zest. Cut orange in half and squeeze juice into a large bowl. Add orange zest, white vinegar, canola oil, and cumin, and stir.
  3. Add red bell pepper, green onions, and black beans to the bowl and stir. Add cooked bulgur, stir well, and serve.

Variation: Add any vegetables you want to this recipe. Also try using a lemon instead of an orange to change the flavor.

DID YOU KNOW?

Bulgur is a quick-cooking form of whole wheat that’s been cleaned, parboiled, dried, ground into particles, and sifted into distinct sizes. It’s versatile and has a pleasant, nutlike flavor.

Spinach Pasta Salad

Feta adds a creamy, slight salty flavor to this nutrient-rich salad. Courtesy of Oldways and the Whole Grains Council, wholegrainscouncil.org.

6 oz. uncooked whole-wheat, whole-rice, or quinoa⁄corn pasta

Juice of 1⁄2 medium lemon (2 TB.)

3 TB. olive oil

2 cloves garlic, minced (2 tsp.)

4 cups fresh spinach leaves, cleaned and chopped

1 (15-oz.) can chickpeas or other white beans, drained and rinsed

2 oz. crumbled feta cheese

Salt

Black pepper

  1. Bring a large saucepan of water to a boil, add pasta, and cook according to package directions.
  2. In a large salad bowl, combine lemon juice, olive oil, and garlic.
  3. Drain pasta, add to dressing in the salad bowl, and stir.
  4. Add spinach, chickpeas, and feta cheese, and stir.
  5. Season with salt and pepper, and serve. Or chill for 1 hour or more.

DIET DO

Whole-grain pasta comes in a lot of varieties. Spiral whole-wheat pasta is good, and takes about 8 minutes to cook. You might want to try rice or corn pasta in this recipe as well.

Armenian Christmas Pudding

This traditional Armenian recipe is filled with an assortment of fresh fruit. Courtesy of Oldways and the Whole Grains Council, wholegrainscouncil.org. Recipe by Sunnyland Mills.

1⁄2 cup bulgur (coarse is best, but any will do)

1⁄2 cup raisins

1⁄2 cup apricots, diced

1⁄2 cup dates, diced

1 qt. water

1⁄4 cup sugar

Walnuts

Almonds, blanched

Pinch cinnamon

  1. In a large saucepan over medium heat, cook bulgur, raisins, apricots, and dates in water for 20 minutes.
  2. Add sugar, stir, and cook for 15 more minutes. Pour into a large bowl or individual serving bowls.
  3. Garnish with walnuts, blanched almonds, and a pinch of cinnamon, and serve.

DID YOU KNOW?

Bulgur is a dried, parcooked wheat popular in the Near East. It’s mild in flavor and cooks quickly.

No Butter! Apple Cranberry Pie

Cinnamon enhances the apples and walnuts in this healthier version of an American classic. Courtesy of Oldways and the Whole Grains Council, wholegrainscouncil.org. Recipe by Cynthia Harriman.

1 large egg

1⁄2 cup sugar

1⁄2 cup whole-wheat flour (regular or pastry)

1 tsp. baking powder

1⁄4 tsp. salt

1⁄2 tsp. ground cinnamon

1⁄4 tsp. vanilla extract

3 small or 2 large McIntosh or your favorite cooking apple, skin on, cored, and chopped

1⁄2 cup dried cranberries

1 cup chopped walnuts or pecans

  1. Preheat the oven to 350°F. Spray a 10-inch pie pan with cooking spray.
  2. In a large bowl, beat egg thoroughly with a fork until it forms a ribbon.
  3. Add sugar, whole-wheat flour, baking powder, salt, cinnamon, and vanilla extract, and stir well with a large spoon.
  4. Add apples, cranberries, and walnuts, and stir well for 4 or 5 minutes with a large spoon (it’s a very lumpy mix).
  5. Pour filling into the prepared pie pan, and bake for 30 minutes.
  6. Serve warm or cool.

DIET DO

This pie has no crust, so it’s quick and healthy. Mix it by hand with a large spoon so the apples don’t get crushed.